How much does surgery cost?

A new report developed by the Royal Australasian College of Surgeons and Medibank sheds light on the variation in costs, length of stay in hospital and re-admissions for some common procedures.

Medibank Chief Medical Officer Dr Linda Swan said the aim of the Surgical Variance Report – General Surgery is to prompt important discussion across the healthcare sector about the different outcomes and experiences patients can have when they need surgery.

“Traditionally, surgeons, GPs and private health customers have had limited access to information on key indicators such as the length of patient stay, rates of readmission or admission to ICU, and prices charged for services,” Dr Swan said.

“We are seeing some encouraging trends in terms of increased awareness for need for transparency. But there is still an enormous amount to be done.”

Dr Swan also highlighted the importance of educating consumers on the difference in out-of-pocket costs between providers.

“Although people understand there might be some out-of-pocket costs associated with their treatment, they don’t necessarily understand yet that that varies from provider to provider and they need to ask the questions up front.”

“If you go and see a provider, absolutely there might be an out-of-pocket costs, but if you go and see another provider there might be a very different experience in terms of out-of-pocket costs.”

The Surgical Variance Report – General Surgery found in 2014-15 and 2015-16:

Colonoscopies

• 114,695 colonoscopies were funded by Medibank in private hospitals, with 1,474 specialists performing the procedure.
• For the 1,270 specialists who billed Medibank for at least five colonoscopies, 32 per cent discharged all their patients on the day of admission.
• For these specialists, the average cost (including payments made by Medibank, Medicare and the patient) ranged between $1,153 and $6,308.

Hernia procedures

• 8,948 hernia procedures were funded by Medibank in private hospitals, with 922 surgeons performing the procedure.
• In 81 per cent of cases, the patient stayed in hospital for at least one night, despite RACS research recommending 70 – 80 per cent of hernia repairs in Australia should be done as same day procedures.
• For the 526 surgeons who billed Medibank for at least five procedures, the average cost (including payments made by Medibank, Medicare and the patient) ranged between $2,430 and $9,933.

Gastric sleeve procedures

• 5,016 gastric sleeve procedures were funded by Medibank in private hospitals, with 169 surgeons performing the procedure.
• For the 116 surgeons who billed Medibank for at least five procedures, the average cost of the procedure ranged between $9,360 and $20,848 (including payments made by Medibank, Medicare and the patient).

Dr Swan said Medibank covered more than 1.3 million hospital admissions in the 2015-16 financial year.

Read the full report here, or read more about going to hospital, including preparing, recovering and understanding hospital costs.